Is There Adequate Perfusion for Healing? What Routine Noninvasive Vascular Studies are Missing?

Routine noninvasive vascular study results can be affected by a multitude of factors and do not provide information specific to the location of the wound. Results must be extrapolated and may prompt a false sense of security that adequate perfusion for healing exists.

The case of an 80-year-old Caucasian man, who presented with chronic ulceration of the left lateral malleolus and fifth metatarsal base with concurrent metatarsal osteomyelitis, is presented. Initial routine noninvasive vascular studies were consistent with peripheral vascular disease and chronic lower extremity wounds. Baseline near-infrared imaging (NIRI) assessment with a handheld device provided site-specific rapid assessment of tissue oxygen saturation, which revealed local ischemia, chronic inflammation, and infection. Wound deterioration over the next 2 months prompted repeat noninvasive vascular studies consistent with increased perfusion while rearfoot transcutaneous oximetry pressure measurements were inconclusive. The patient underwent formal vascular evaluation and intervention. Repeat NIRI assessment 5 days postoperatively revealed transition from the chronic inflammatory to the proliferative phase of wound healing.

Serial NIRI assessment in this case highlights its ability to detect factors that led to delayed would healing in the face of unreliable routine noninvasive vascular study results.